A Retrospective Study Of Advanced Early-onset Colorectal Cancer And Later-onset Colorectal Cancer

BackgroundColorectal cancer(CRC)is one of the most common digestive tract cancers in the world.Incidence rate and mortality rate of colorectal cancer have been decreasing steadily in some countries and regions along with the progress of colorectal cancer screening and diagnosis and treatment.However,the incidence rate and mortality rate of early onset colorectal cancer are increasing.Because there may be different pathogenesis and clinical characteristics between early-onset colorectal cancer and later-onset colorectal cancer,it affects the choice of treatment strategy and prognosis.Therefore,further study on the clinical characteristics and prognosis of the two groups will help to provide a more optimized diagnosis and treatment for patients with advanced colorectal cancer,prolong the survival time and reduce the risk of death.PurposeBy comparing the clinical data of advanced eoCRC and loCRC,the differences of clinical characteristics and prognostic factors between the two groups were analyzed to provide data support for further prospective study.MethodsThis study applied a retrospective method to collate and analyze the data of advanced CRC after chemotherapy failure in the trial data management system of Xiyuan Hospital's Institute of Clinical Pharmacology,China Academy of Chinese Medical Sciences.Categorical variables and continuous variables were tested by chi-square test and independent sample T test respectively.Survival data were analyzed by K-M method and survival curve was drawn The difference was statistically significant(p<0.05).Cox regression model test was used for factors that may affect the prognosis of patients to explore independent factors that influence their prognosis.Results1.In this study,372 patients with advanced colorectal cancer who failed conventional chemotherapy were included,including 87 in the early-onset group,with an average age of(43.62 ± 6.31)years,and the ratio of men and women was 1.72:1;285 in the late-onset group,with an average age of(62.02 ± 6.62)years,with a ratio of men and women of 1.74:1.There was no significant difference in gender distribution between the two groups(P>0.05).There was no significant difference between the two groups in tumor location,pathological type,tumor differentiation degree,KRAS and BRAF gene status,number of metastasis organs,liver metastasis,time of stage ? diagnosis,KPS score and TCM syndrome type(p>0.05);there was significant difference between the two groups in lung metastasis,number of existing treatment lines,previous targeted treatment and evaluation after the last treatment(p<0.05).2.As of November 30,2019,66 patients died in the early-onset group,21 with deletion data,and the median follow-up time was 7.8 months;182 patients died in the late-onset group,103 with deletion data,and the median follow-up time was 9.5 months.The total survival time of early-onset group and late-onset group was 8.3 months and 11.73 months,respectively.There was significant difference between the two groups(HR=1.359(1.003-1.842),p<0.05).The 1-year and 2-year survival rates of the two groups were 40.23%and 49.1%respectively,and 20.1%and 36.1%respectively.3.The risk of death was higher and the survival time was shorter in patients with advanced early onset colorectal cancer who had a positive liver metastasis,a negative lung metastasis,KPS score<70 and last assessment of disease progression.4.In the aspect of TCM syndrome differentiation and treatment,the median survival time of the early-onset group from long to short was phlegm and dampness syndrome,spleen and kidney deficiency syndrome,stasis and toxin syndrome,qi and blood deficiency syndrome and liver and kidney deficiency syndrome,respectively,20.6 months,14.03 months,7.57 months,6.97 months and 5.535 months;In the late-onset group,the median survival time from long to short is as follows:spleen and kidney deficiency syndrome,liver and kidney deficiency syndrome,phlegm and dampness syndrome,stasis and toxin syndrome,qi and blood deficiency syndrome,respectively,15.8 months,11.17 months,11.17 months,11.3 months and 7.085 months.5.The results of univariate analysis showed that KPS score(p=0.001)and pathological type(p=0.001)in early-onset group were related to their prognosis,while the primary site(p<0.001),differentiation degree(p=0.008)and KPS score(p=0.002)in late-onset group were related to their prognosis.6.Multivariate analysis showed that KPS score(p=0.001)and pathological type(p=0.001)were independent factors influencing the prognosis.The location of primary tumor(p=0.002),differentiation degree(p=0.005)and KPS score(p=0.001)were independent factors influencing the prognosis of late-onset group.Conclusions:1.The early onset group was different from the late onset group in lung metastasis,previous treatment and post-treatment evaluation.2.Compared with patients of lo-CRC,patients of eo-CRC have poor prognosis3.The risk of death was higher and the survival time was shorter in patients with advanced early onset colorectal cancer who had a positive liver metastasis,a negative lung metastasis and a KPS score of less than 704.In terms of TCM syndrome differentiation,the prognosis of patients with phlegm and dampness syndrome in the early-onset group is better.The prognosis of the patients with spleen and kidney deficiency was better in the late onset group,and the prognosis of the patients with qi and blood deficiency was the worst in the two groups.5.KPS score<70 and pathological type of non adenocarcinoma were independent risk factors for prognosis in early-onset group6.In the late-onset group,the right colon,poorly differentiated and undifferentiated cancer and KPS score<70 were independent risk factors for prognosis.